Inmate deaths across New York linked to medical company

Apr. 13, 2013

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Medical Review Board reports

The New York State Commission of Correction’s Medical Review Board conducts reviews of inmate fatalities, including suicides, deaths from use of force, and other unusual circumstances. The Medical Review board found at least some level of fault with CMC in the deaths of nine jail inmates at facilities contracted with the medical provider between 2009 and 2011. • Latisha Mason, 28, was booked into the Schenectady County Jail on Feb. 4, 2011, after she was accused of refusing to leave a Subway restaurant. She allegedly attempted to assault an employee with a coffee pot. On Feb. 9, Mason died of undetermined causes associated with PCP-related complications. In a report issued last year, the review board determined CMC failed to comply with state regulations and its own policies mandating increased supervision for apparently intoxicated inmates. • Justin McCue, 26, hanged himself at the Dutchess County Jail on Sept. 23, 2010. The Medical Review Board alleged CMC removed McCue from constant supervision without consulting a psychiatrist, and that mental health services for McCue were discontinued with “no valid basis.” • Maria Viera, 53, died on Sept. 2, 2010, from myocarditis, or inflammation of the heart muscle, while in the Monroe County Jail. The Medical Review Board said an inexperienced CMC nurse failed to follow proper detoxification procedures. • Thomas Siewert, a 51-year-old former HVAC technician, was found on a sidewalk outside a Kmart store in Dutchess County on Feb. 3, 2011. Town of Poughkeepsie police booked him for two outstanding warrants for DWI at the Dutchess County Jail. He reported episodes of depression in between panic attacks, and expressed concern he wasn’t being properly medicated. CMC personnel failed to conduct formal, scheduled follow-up on the complaints, according to the state report. He committed suicide Feb. 11, 2011. • Richard Vandemark, 21, hanged himself the day after he was booked into the Ulster County Jail. In its report on his death, the medical board directed CMC to review its mental health procedures. A wrongful death lawsuit, filed by Vandemark’s family, resulted in a $250,000 settlement, according to an agreement obtained by the newspaper. • Kevin Schmitt, who ran a landscaping and snow-removal business with his ex-wife, was accused of confronting her and a man with two loaded rifles before barricading himself from authorities for 10 hours. The CMC-employed social worker who booked Schmitt performed a “grossly incompetent, flagrantly substandard” evaluation, the review board determined. The next day, after Schmitt was let out of his cell to use the phone, he walked up a flight of stairs and dove head-first off a balcony. • Joaquin Rodriguez, a 60-year-old with mental and physical ailments, including diabetes, was booked into the Monroe County Jail on July 14, 2009, after his continued drug use resulted in his discharge from a drug court program. According to the review board, Rodriguez faked his own suicide to draw attention to stomach problems he had complained of, hoping to get treatment. The morning after the staged suicide attempt, a porter delivering breakfast trays discovered Rodriguez’s body in a fetal position, surrounded by a copious amount of bodily fluid and vomit.

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Frederick Haag hanged himself after the Tioga County Jail’s private medical provider failed to follow proper procedures to evaluate his mental health.

In the Broome County jail, Alvin Rios died of a heart condition after the same medical provider failed to give the required care for a person undergoing drug withdrawal.

Joaquin Rodriguez, a diabetic, was critically ill with pneumonia for 36 hours without medical care before authorities found his corpse in the Monroe County Jail.

The three are among nine inmates whose deaths between 2009 and 2011 in county jails that contract with Correctional Medical Care Inc. have resulted in critical reports by the state Commission of Correction, which oversees jails and prisons and investigates inmate deaths.

The state Attorney General’s Office said this week it is involved in an investigation of CMC.

Despite the criticism, CMC in the last 11 years has grown to become the state’s largest private contract provider of jail medical services.

Broome County, among the 13 counties that use CMC, could decide as early as Thursday to sign a three-year, $9.2 million extension of its contract with the firm.

CMC, whose comprehensive menu of services ranges from filling cavities to treating illnesses, said it uses some of the most qualified and dedicated licensed medical personnel in New York state. The company is based in Blue Bell, Pa.

“Together with these health care professionals, we pride ourselves on arranging for the highest quality health care to inmates in the most cost-effective manner for our local government clients and, in turn, New York’s taxpayers,” CMC spokeswoman Jessica Bassett said.

The company touted its years of service in correctional facilities and noted the jails meet or exceed local and national standards established by the National Commission on Correctional Healthcare.

“The reality is we do this work better than anyone else in our field because we focus first on delivering first-rate care to the incarcerated population,” Bassett said. “And due to our experience, we can provide that top-notch care cost-effectively.”

Nazif Chowdhury, who serves as CMC’s director of utilization management, said the company’s medical professionals care for inmates just as they would anyone in a hospital or other clinical setting. But the inmates often bring untreated medical and mental health problems to the facility, he said.

“These are the patients that most clinics would dread getting, because they’re complex,” Chowdhury said. “Essentially, they’re train wrecks.”

Yet, reports by the New York State Commission of Correction’s Medical Review Board have found some level of fault with the CMC in the nine inmate deaths. In some cases, the review board also has placed partial blame on correctional officers for mistakes that contributed to the fatalities.

The Medical Review Board has blamed CMC for failing to follow its own drug withdrawal and detoxification policies, for ignoring signs of mental illness and for failing to treat some illnesses.

Three of its reports on the nine deaths recommend county-level inquiries to decide whether CMC is fit to continue to provide services at the Broome, Tioga and Dutchess county jails. Following Rodriguez’s death, the Medical Review Board recommended that Monroe County immediately terminate its contract with CMC.

'Life-threatening status'

The CMC has provided medical services at the Broome County Correctional Facility since 2006 for contracts worth more than $18 million through the end of 2013.

With county lawmakers set to consider extending that contract Thursday, Sheriff David Harder expressed satisfaction with CMC’s track record.

“We pay CMC a hefty dollar, so we’re concerned about the treatment,” Harder said. “Our complaints by the inmates against the medical (care) are very few. And believe me, when they come in here, they have every problem in the world to be treated.”

Harder said CMC nurses provide 24/7 treatment for inmates who may not have seen a doctor or received medical service on the outside. A special unit treats inmates for mental health issues Monday through Friday.

Meanwhile, Broome County and CMC have been sued in Supreme Court by Rios’ family.

According to the state medical review board’s report, CMC failed to implement its own intoxication and withdrawal policy and procedure after Rios was booked into the jail following his July 19, 2011, arrest on a warrant for criminal possession of a controlled substance.

The doctor, who was at the jail for more than eight hours the next day, was not made aware by nurses of Rios’ condition. In a statement later to the Commission of Correction, the doctor said he “never touched the chart.”

The report states on July 20, Rios was left “in an emergent, life-threatening status without appropriate medical attention,” before a corrections officer heard a “thud” from Rios’ cell at 4:21 p.m.

“Officer D.T. checked on Rios and saw him laying face down and shaking,” states the report, which like others by the Medical Review Board, identifies medical workers and jail personnel only by their initials. The report was also heavily redacted before being released through a state Freedom of Information Law request.

The officer then notified a CMC registered nurse. Rios was pronounced dead an hour later. His death later was determined to be caused by “cardiac arrhythmia produced by cardiomyopathy” — an abnormal heart rhythm stemming from a deterioration of the heart muscle — “from illicit drug use.”

As a result of Rios’ death, the Medical Review Board recommended Broome County conduct an inquiry into CMC’s fitness as a correctional medical care provider, “specifically for its failure to implement its own intoxication and withdrawal policy and procedure ...”

Following the Medical Review Board’s completion of the five-page report in June 2012, Harder wrote to the Commission of Correction in July to say steps had been taken to ensure that CMC complied with the commission’s recommendations.

“The Sheriff’s Office monitored the development and implementation of the actions taken by the medical service providers,” Harder wrote.

A resolution on the agenda for the Broome County Legislature’s session on Thursday would authorize County Executive Debbie Preston to renew the contract with CMC. Preston, through a county spokesman, declined to comment for this report.

Legislature Majority Leader Ron Keibel, R-District 9, said he and other lawmakers generally rely on recommendations by Harder and jail personnel.

“We listen to their recommendations because they surely have more firsthand knowledge than we do,” he said.

Told of the inmate deaths reports, Minority Leader Daniel D Reynolds, D-District 4, said he plans to look into the issue further.

Last week, the state Attorney General’s Office confirmed CMC is the subject of an inquiry.

“We are involved in an investigation,” said spokeswoman Michelle Hook, who declined to provide further details.

Thomas Dunn, a spokesman for the state Education Department, which oversees licensing for professions including medicine, said the department is “working with the attorney general.”

'Superb' service

Contracted medical providers are used at county jails in 15 of New York’s 62 counties. Of those contracts, 11 — including Broome and Tioga counties in the Southern Tier — are held by CMC. An additional two counties contract with CMC for mental health services only.

The company was formed in May 2001 by Emre Umar, a former insurance market analyst and the son of a physician. By 2002, CMC had signed its first two contracts with Montgomery County, Pa., and Ulster County to provide medical services at the county correctional facilities.

CMC’s tenure at the Montgomery County Prison, between 2002 and 2011, was not without road bumps, including at least two deaths that led to legal settlements totaling more than $200,000. CMC has also held contracts in the past with the Atlantic County Jail in New Jersey and the Bristol County Jail in Massachusetts.

Since 2005, the firm has operated primarily in New York, where some of its biggest backers are the county sheriffs.

Counties like contracting with private medical providers because some assume liability when legal issues arise.

Schenectady County Sheriff Dominic Dagostino described CMC’s services as “nothing short of superb.” The company has kept complaints to a minimum, he said, and when an issue does come up, it’s resolved in 15 to 20 minutes.

“Jails are becoming a much more unhealthy population,” he said. “They’ve adapted to that and provided a level of service that is very, very good.”

“Every time there is an incident, they’re receptive. We sit down, we talk about it,” said Ulster County Sheriff Paul Van Blarcum, who is in his seventh year working with the company.

“When we go out to bid, no one even comes close to them. And I understand it’s not all about money. You want to have your bidder also to be responsible,” he said.

CMC has also been a big backer of New York’s county sheriffs. The company and Umar have contributed a combined total of $22,900 to their campaign funds since 2009, state election records show.

Tioga County

The Medical Review Board’s latest report concerning the death of an inmate under CMC’s care details missteps that preceded the death of Haag, who was booked into the Tioga County jail in July 2011 after allegedly e-mailing an ex-girlfriend in violation of a protection order.

Upon admission to the jail, a nurse failed to complete an admission assessment. Haag experienced periods of hopelessness, helplessness and paranoia and exhibited mood swings, representing “a clear danger signal that went unrecognized by CMC, Inc. clinicians,” the Medical Review Board later determined.

It also stated the CMC-employed mental health director, who was allegedly working without the proper state license — a charge CMC disputes — failed to complete a competent mental health assessment diagnosis or refer him to psychiatrist.

“Despite Haag being visibly upset and exhibiting signs and symptoms of acute depression,” the Medical Review Board wrote, “he was not referred to a psychiatrist for intervention or a medication evaluation, which represents grossly inadequate mental health care by CMC, Inc.”

Other details of the deficiencies in Haag’s care are concealed by heavy redactions in the Medical Review Board’s 10-page report, but the board said his tenure at the jail was marked by “grossly and flagrantly improper and inadequate care.”